BILL NUMBER: SB 220 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 31, 2010
PASSED THE ASSEMBLY AUGUST 30, 2010
AMENDED IN ASSEMBLY AUGUST 24, 2010
AMENDED IN ASSEMBLY AUGUST 20, 2010
AMENDED IN ASSEMBLY AUGUST 16, 2010
AMENDED IN ASSEMBLY JUNE 24, 2010
AMENDED IN ASSEMBLY MAY 26, 2010
AMENDED IN ASSEMBLY MARCH 11, 2010
AMENDED IN ASSEMBLY JULY 16, 2009
AMENDED IN ASSEMBLY JULY 2, 2009
AMENDED IN SENATE APRIL 13, 2009
INTRODUCED BY Senator Yee
(Coauthor: Assembly Member Hill)
FEBRUARY 23, 2009
An act to add Sections 1367.002 and 1367.002.1 to the Health and
Safety Code, and to add Sections 10112.2 and 10112.21 to the
Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 220, Yee. Health care coverage: preventive health services:
tobacco cessation.
Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), enacts various health care coverage market reforms. With
respect to plan years beginning on and after September 23, 2010, the
act requires health insurance issuers to provide coverage, and not
impose cost-sharing requirements, for certain preventive health
services. PPACA also requires each state to, by January 1, 2014,
establish an American Health Benefit Exchange that facilitates the
purchase of qualified health plans by qualified individuals and
qualified small employers, as specified.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care and makes a violation of the act a
crime. Existing law provides for the regulation of health insurers by
the Department of Insurance. Existing law requests the University of
California to establish the California Health Benefits Review
Program to assess legislation proposing to mandate a benefit or
service and legislation proposing to repeal a mandated benefit or
service, as specified.
This bill would require certain health care service plan contracts
and health insurance policies issued, amended, renewed, or delivered
on or after September 23, 2010, to provide coverage, and not impose
cost-sharing requirements, for certain preventive health services
consistent with federal law.
The bill would also require certain health care service plan
contracts and health insurance policies issued, amended, renewed, or
delivered on or after January 1, 2011, to provide coverage for
tobacco cessation treatment that includes specified courses of
treatment and medication. The bill would request the University of
California, as part of the California Health Benefits Review Program,
to prepare a report regarding any state savings as a result of this
coverage requirement. The bill would make the coverage requirement
inoperative upon a determination that it will result in the state
assuming additional costs, as specified.
Because a willful violation of the bill's provisions relative to
health care service plans would be a crime, the bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature hereby finds and declares the
following:
(a) It is the intent of the Legislature that this act diminish the
statewide economic and personal cost of tobacco addiction by making
tobacco cessation treatments available to all smokers.
(b) Cigarette smoking and other uses of tobacco remain the leading
cause of preventable death in California, as well as the cause of
many other serious health problems, including heart disease,
emphysema, and other chronic illnesses.
(c) The treatment of tobacco-related diseases continues to impose
a significant burden on California's health care system, including
local and state funded health care systems. Tobacco use costs
Californians billions of dollars a year in medical expenses and lost
productivity.
(d) Providing tobacco cessation counseling and medication is one
of the most clinically effective and cost-effective health services
available, second only to inoculations.
(e) Reducing the smoking rate in California by one percentage
point will result in approximately $91 million saved over five years
from fewer smoking-caused heart attacks and strokes.
(f) The United States Public Health Service Clinical Practice
Guideline entitled Treating Tobacco Use and Dependence has identified
the medications and counseling that are scientifically proven to be
effective in helping smokers quit.
SEC. 2. Section 1367.002 is added to the Health and Safety Code,
to read:
1367.002. To the extent required by federal law, a group or
individual health care service plan contract that is issued, amended,
renewed, or delivered on or after September 23, 2010, shall comply
with the requirements of Section 2713 of the federal Public Health
Service Act (42 U.S.C. Sec. 300gg-13), as added by Section 1001 of
the federal Patient Protection and Affordable Care Act (Public Law
111-148), and any subsequent rules or regulations issued pursuant to
that section.
SEC. 3. Section 1367.002.1 is added to the Health and Safety Code,
to read:
1367.002.1. (a) (1) A health care service plan contract issued,
amended, renewed, or delivered on or after January 1, 2011, shall
cover a minimum of two courses of treatment in a 12-month period for
all smoking cessation treatments rated "A" or "B" by the United
States Preventive Services Task Force, which shall include counseling
and over-the-counter medication and prescription pharmacotherapy
approved by the federal Food and Drug Administration.
(2) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
section shall preclude a health care service plan from allowing
enrollees to access tobacco cessation services on a self-referral
basis.
(3) As used in this section, "course of treatment" shall be
defined to consist of the following:
(A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
(B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
(4) Enrollees shall not be required to enter counseling in order
to receive tobacco cessation medications after the patient's first
course of treatment.
(5) A health care service plan may not impose prior authorization
or stepped-care requirements on tobacco cessation treatments after
the patient's first course of treatment.
(b) This section shall not apply to Medicare supplement plan
contracts or to specialized health care service plan contracts.
(c) The Legislature hereby requests that the University of
California, as part of the California Health Benefits Review Program
established under Section 127660, prepare a report by December 31,
2013, evaluating the requirements of this section and determining any
state savings as a result of those requirements. The Legislature
requests that this report be made available to the Legislature, the
Department of Insurance, and the Department of Managed Health Care.
(d) This section shall become inoperative on the date that the
state determines that, taking into account any state savings
identified under subdivision (c), the requirements of this section
will result in the state assuming additional costs pursuant to
subparagraph (B) of paragraph (3) of subsection (d) of Section 1311
of the federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by subsection (e) of Section 10104 of Title X
of that act.
SEC. 4. Section 10112.2 is added to the Insurance Code, to read:
10112.2. To the extent required by federal law, a group or
individual health insurance policy that is issued, amended, renewed,
or delivered on or after September 23, 2010, shall comply with the
requirements of Section 2713 of the Public Health Service Act (42
U.S.C. Sec. 300gg-13), as added by Section 1001 of the Patient
Protection and Affordable Care Act (Public Law 111-148), and any
subsequent rules or regulations issued pursuant to that section.
SEC. 5. Section 10112.21 is added to the Insurance Code, to read:
10112.21. (a) (1) A health insurance policy issued, amended,
renewed, or delivered on or after January 1, 2011, shall cover a
minimum of two courses of treatment in a 12-month period for all
smoking cessation treatments rated "A" or "B" by the United States
Preventive Services Task Force, which shall include counseling and
over-the-counter medication and prescription pharmacotherapy approved
by the federal Food and Drug Administration.
(2) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
section shall preclude an insurer from allowing insureds to access
tobacco cessation services on a self-referral basis.
(3) As used in this section, "course of treatment" shall be
defined to consist of the following:
(A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
(B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
(4) Insureds shall not be required to enter counseling in order to
receive tobacco cessation medications after the patient's first
course of treatment.
(5) A health insurer shall not impose prior authorization or
stepped-care requirements on tobacco cessation treatments after the
patient's first course of treatment.
(b) This section shall not apply to Medicare supplement policies
or to specialized health insurance policies.
(c) The Legislature hereby requests that the University of
California, as part of the California Health Benefits Review Program
established under Section 127660 of the Health and Safety Code,
prepare a report by December 31, 2013, evaluating the requirements of
this section and determining any state savings as a result of those
requirements. The Legislature requests that this report be made
available to the Legislature, the Department of Insurance, and the
Department of Managed Health Care.
(d) This section shall become inoperative on the date that the
state determines that, taking into account any state savings
identified under subdivision (c), the requirements of this section
will result in the state assuming additional costs pursuant to
subparagraph (B) of paragraph (3) of subsection (d) of Section 1311
of the federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by subsection (e) of Section 10104 of Title X
of that act.
SEC. 6. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.